Table 3.

Part D Claims Rejections in the Nursing Home Setting, Across Plans (2010)

Plansa With Most Total Claims	Total Claims	Total Rejections	Rejection Rate	Proportion of Rejections in Each Category
				Product Not Covered	Utilization Management	Administrative Rejections
Plan A	1,055,608	205,069	19%	11.0%	58.8%	30.2%
Plan B	981,127	230,817	24%	5.2%	26.5%	68.3%
Plan C	338,268	51,610	15%	12.0%	65.7%	22.3%
Plan D	241,402	39,677	16%	10.5%	34.5%	55.0%
Plan E	158,545	23,373	15%	10.4%	60.8%	28.7%
Plan F	156,522	26,758	17%	13.4%	42.5%	44.1%
Plan G	140,699	15,994	11%	13.7%	54.5%	31.8%
Plan H	130,105	13,109	10%	13.0%	58.2%	28.9%
Plan I	119,497	30,275	25%	17.8%	50.9%	31.3%
Plan J	105,496	31,920	30%	3.6%	22.7%	73.7%
Plan K	78,468	10,799	14%	31.5%	49.4%	19.2%
Plan L	74,093	10,033	14%	19.4%	51.2%	29.4%
Plan M	42,429	7082	17%	8.6%	39.2%	52.2%
Plan N	40,827	2423	6%	22.5%	30.6%	46.8%
Plan O	30,925	5195	17%	36.5%	40.6%	22.9%
Plan P	25,691	4235	16%	23.0%	50.5%	26.4%
Plan Q	23,775	3190	13%	41.4%	17.3%	41.3%
Plan R	15,948	4693	29%	18.0%	17.0%	65.0%
Plan S	13,798	2450	18%	28.7%	30.2%	41.1%
Plan T	12,074	3528	29%	5.2%	52.4%	42.4%
Plan U	10,262	1179	11%	0.9%	82.3%	16.8%

^aIf company had multiple Part D plans nationwide, the information is aggregated across these plans.

Source: Authors’ analysis of data provided by Omnicare, Inc, the nation’s largest long-term care pharmacy. Data include all paid and rejected Part D claims from the month of March in each study year.